Direct approach to arteriovenous malformations in functional areas of the cerebral hemisphere

1990 ◽  
Vol 72 (3) ◽  
pp. 418-425 ◽  
Author(s):  
Shokei Yamada ◽  
Floyd S. Brauer ◽  
David S. Knierim
Keyword(s):  
Arteriovenous Malformations ◽  
Surgical Intervention ◽  
Neurological Complications ◽  
Cortical Tissue ◽  
Functional Area ◽  
Controlled Hypotension ◽  
Content Type ◽  
Arterial Blood ◽  
History Of ◽  
Functional Areas

✓ The natural history of patients with arteriovenous malformations (AVM's) suggests that serious morbidity associated with AVM's in functional areas is likely to be much greater than in silent areas. Various modes of treatment of AVM's in functional areas, including direct surgical intervention, embolization, and irradiation, have been considered to carry high risks. The authors advocate direct surgical intervention to these AVM's via a microsurgical technique based on knowledge of the hemodynamic anatomy of AVM's. The technique is designed to circumscribe the AVM without removing any surrounding cortical tissue or white matter and to preserve microcirculation in the functional area. Controlled hypotension (mean arterial blood pressure 40 to 60 mm Hg) is appropriate to enhance the safety of surgical procedures without causing metabolic and electrophysiological dysfunction. Another means to prevent neurological complications is multi-staged resection of larger AVM's, which permits obliteration compartment by compartment. This technique has the advantage of maintaining circulatory sufficiency in the functional area. There was no mortality among 56 patients who underwent the surgical procedure described. Of those, 55 patients resumed their preoperative occupation and one patient became self-sufficient.

Linear accelerator radiosurgery for arteriovenous malformations

1992 ◽  
Vol 77 (6) ◽  
pp. 832-841 ◽  
Author(s):  
William A. Friedman ◽  
Frank J. Bova
Keyword(s):  
Arteriovenous Malformations ◽  
Neurological Complications ◽  
Lesion Size ◽  
University Of Florida ◽  
Content Type ◽  
Radiation Induced ◽  
The Mean ◽  
Complete Thrombosis ◽  
The University ◽  
Thrombosis Rate

✓ Between May, 1988, and August, 1991, 80 patients with arteriovenous malformations (AVM's) were treated radiosurgically at the University of Florida. A mean dose of 1650 cGy was directed to the periphery of the lesion, which almost always corresponded to the 80% isodose line. The mean lesion diameter was 23 mm. Seventy-six patients were treated with one isocenter. Angiography, performed at 1 year after radiosurgery in 41 of the 48 eligible patients, revealed an overall complete thrombosis rate of 39%. The 1-year thrombosis rate was highest in those patients with relatively small AVM's. Angiography was performed at 2 years posttreatment in 21 of the 25 eligible patients, demonstrating an overall complete thrombosis rate of 81%. This incidence did not correlate with lesion size: that is, large lesions (up to 35 mm in diameter) seemed just as likely to thrombose. Two patients (2.5%) experienced hemorrhage at some time after radiosurgical treatment, and both recovered. Two patients (2.5%) have sustained mild, but permanent, radiation-induced neurological complications.

Medial occipital arteriovenous malformations

1982 ◽  
Vol 56 (6) ◽  
pp. 798-802 ◽  
Author(s):  
Neil A. Martin ◽  
Charles B. Wilson
Keyword(s):  
Visual Field ◽  
Arteriovenous Malformations ◽  
Posterior Cerebral Artery ◽  
Occipital Region ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Visual Field Deficit ◽  
History Of ◽  
Migrainous Headache ◽  
Fine Print

✓ In a consecutive operative series of 115 intracranial arteriovenous malformations (AVM's), 16 occupied the medial occipital region. Typically, the patients with medial occipital AVM's presented with bleeding, often accompanied by homonymous visual field deficit, or with migrainous headache. The malformations were supplied principally by branches of the posterior cerebral artery. Through an occipital craniotomy, a surgical approach along the junction of the falx and tentorium provided access to the arteries feeding the AVM and facilitated excision of the malformation. There were no deaths in the series. The incidence of visual field deficit after the operation varied, but in only five cases was the visual field worsened postoperatively. All patients who had a history of intractable headache were cured or improved after surgery. These lesions are favorably situated for surgical treatment.

Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization

1984 ◽  
Vol 60 (4) ◽  
pp. 777-785 ◽  
Author(s):  
Alex Berenstein ◽  
Wise Young ◽  
Joseph Ransohoff ◽  
Vallo Benjamin ◽  
Henry Merkin
Keyword(s):  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Arteriovenous Malformations ◽  
Therapeutic Embolization ◽  
Neurological Complications ◽  
Anterior Spinal Artery ◽  
Spinal Angiography ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.

The natural history of aneurysms and arteriovenous malformations

1985 ◽  
Vol 62 (3) ◽  
pp. 321-323 ◽  
Author(s):  
John A. Jane ◽  
Neal F. Kassell ◽  
James C. Torner ◽  
H. Richard Winn
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Arteriovenous Malformations ◽  
Anterior Cerebral Artery ◽  
Unknown Etiology ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
History Of ◽  
Fine Print

✓ The authors summarize the findings of previous studies relating to the natural history of aneurysms and arteriovenous malformations (AVM's). Ruptured aneurysms have their highest rate of rebleeding on Day 1, and at least 50% will rebleed during the 6 months after the first hemorrhage. Thereafter, the rate drops to at least 3% a year. This is the same rate as seen in anterior and posterior communicating artery aneurysms treated by anterior cerebral artery clipping and carotid ligation; these operations provide immediate protection but do not result in long-term diminution of the risk of rebleeding. Patients with unruptured incidental and unruptured multiple aneurysms rebleed at a rate of 1% per year, as do patients with subarachnoid hemorrhage of unknown etiology. The risk of rebleeding for AVM's is 3% a year.

Stereotactic radiosurgery for brainstem arteriovenous malformations: factors affecting outcome

2004 ◽  
Vol 100 (3) ◽  
pp. 407-413 ◽  
Author(s):  
Keisuke Maruyama ◽  
Douglas Kondziolka ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Radiation Effects ◽  
Three Dimensional ◽  
Neurological Complications ◽  
Long Term Results ◽  
Management Options ◽  
Content Type ◽  
Dose Planning ◽  
Fine Print

Object. Management options for arteriovenous malformations (AVMs) of the brainstem are limited. The long-term results of stereotactic radiosurgery for these disease entities are poorly understood. In this report the authors reviewed both neurological and radiological outcomes following stereotactic radiosurgery for brainstem AVMs over 15 years of experience. Methods. Fifty patients with brainstem AVMs underwent gamma knife surgery between 1987 and 2002. There were 29 male and 21 female patients with an age range of 7 to 79 years (median 35 years). Anatomical locations of these AVMs included the midbrain (39 lesions), pons (20 lesions), and medulla oblongata (three lesions). The radiation dose applied to the margin of the AVM varied from 12 to 26 Gy (median 20 Gy). Forty-five patients were followed up from 5 to 176 months (mean 72 months). The angiographically confirmed actuarial obliteration rate was 66% at the final follow-up examination. Two patients experienced a hemorrhage before obliteration. The annual hemorrhage rate was 1.7% for the first 3 years after radiosurgery and 0% thereafter. Patients who had received irradiation at two or fewer isocenters had higher obliteration rates (80% compared with 44% for > two isocenters, p = 0.006), and this was related to a more spherical nidus shape. The rate of persistent neurological complications in patients treated using magnetic resonance imaging—based dose planning after 1993 was 7%, compared with 20% in patients treated before 1993. An older patient age, a lesion located in the tectum, and a higher radiosurgery-based score were significantly associated with greater neurological complications. Conclusions. Stereotactic radiosurgery provided complete obliteration of AVMs in two thirds of the patients with a low risk of latency-interval hemorrhage. Better three-dimensional imaging studies and conformal dose planning reduced the risk of adverse radiation effects. Younger patients harboring more spherical AVMs that did not involve the tectal plate had the best outcomes.

Embolization of cerebral arteriovenous malformations with bucrylate

1982 ◽  
Vol 56 (5) ◽  
pp. 615-627 ◽  
Author(s):  
Gérard Debrun ◽  
Fernando Vinuela ◽  
Allan Fox ◽  
Charles G. Drake
Keyword(s):  
Surgical Resection ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Neurological Complication ◽  
Memory Loss ◽  
Neurological Complications ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Group I ◽  
Complete Obliteration

✓ Forty-six patients with cerebral arteriovenous malformations (AVM's) were selected for embolization with bucrylate. These patients were assigned to three different groups. Group I consisted of 22 patients with nonresectable AVM's who were selected for embolization with a Silastic calibrated-leak balloon. In 16 of these patients, embolization was achieved, with partial obliteration of the AVM in 14 and complete obliteration in two. Five patients had subarachnoid hemorrhage caused by the balloon bursting and concomitant dissection of the feeding vessel. Four of these patients recovered completely and one died of a brain-stem hemorrhage. A permanent field defect was noted in five cases, and two patients had a transient mild neurological deficit. Group II consisted of 13 patients treated by intraoperative embolization. Complete obliteration by embolization was obtained in four cases, and complete surgical resection after embolization in five. Partial embolization with no surgical resection was achieved in five cases. Three of these patients had a permanent mild neurological deficit and two had transient deficits. There was no mortality in this group. Group III consisted of 11 patients treated by embolization with bucrylate using a new latex calibrated-leak balloon. This balloon has a higher malleability, and takes on the exact configuration of the feeder, with no risk of dissection. This balloon also permits delivery of a faster and larger injection of bucrylate to the arterial feeders of the AVM. Two AVM's were completely obliterated, and embolization was only partially successful in the other cases. Neurological complications consisted of incomplete field defects in two cases, slight memory loss in one case, and transient clumsiness of the arm and face in one case. Two patients have a catheter permanently glued in the malformation, with no neurological complication. There was no mortality in this group.

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment

1990 ◽  
Vol 73 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Stephen L. Ondra ◽  
Henry Troupp ◽  
Eugene D. George ◽  
Karen Schwab
Keyword(s):  
Mortality Rate ◽  
Arteriovenous Malformations ◽  
Original Population ◽  
Major Morbidity ◽  
Content Type ◽  
History Of ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.

Thrombosed arteriovenous malformations of the brain

1982 ◽  
Vol 57 (4) ◽  
pp. 520-526 ◽  
Author(s):  
Robert E. Wharen ◽  
Bernd W. Scheithauer ◽  
Edward R. Laws
Keyword(s):  
Arteriovenous Malformations ◽  
Previous History ◽  
Low Grade ◽  
Spontaneous Thrombosis ◽  
Radiographic Findings ◽  
Content Type ◽  
Seizure Disorders ◽  
History Of ◽  
Mass Lesions ◽  
The Brain

✓ Thrombosed arteriovenous malformations (AVM's) in patients with no previous history of hemorrhage are uncommon but benign lesions that present with clinical and radiographic findings which are often indistinguishable from those of other mass lesions, particularly low-grade gliomas. The authors report seven cases of thrombosed AVM's presenting as intractable seizure disorders in which the radiographic studies had suggested a low-grade glioma. All seven patients are now seizure-free 2 to 40 months postoperatively. The importance of surgical exploration in the management of such patients is emphasized. A review of 32 cases reported in the literature is presented. The reasons why angiography may fail to demonstrate an AVM, and the possible etiologies for the spontaneous thrombosis of an AVM are discussed.

Surgical embolization of cerebral arteriovenous malformations through internal carotid and vertebral arteries

1975 ◽  
Vol 42 (4) ◽  
pp. 443-451 ◽  
Author(s):  
Alfred J. Luessenhop ◽  
John H. Presper
Keyword(s):  
Arteriovenous Malformations ◽  
Previous History ◽  
Surgical Excision ◽  
Clinical Results ◽  
Prior History ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Progressive Neurological Deficit ◽  
History Of

✓ The authors describe the clinical results of surgical embolization in 55 patients with large cerebral arteriovenous malformations. Follow-up intervals ranged from 2 months to 14 years, averaging 4½ years. The authors believe the procedure is safe in properly selected patients and is useful as a preliminary to direct surgical excision. It relieves associated headaches, and usually reverses or stabilizes a progressive neurological deficit. The potential for seizures probably is not altered. The incidence of hemorrhage following embolization is low for patients with no previous history of hemorrhage; however, the procedure does not reduce the likelihood of recurrence in patients with a prior history of hemorrhage.

The risk of hemorrhage after radiosurgery for arteriovenous malformations

1996 ◽  
Vol 84 (6) ◽  
pp. 912-919 ◽  
Author(s):  
William A. Friedman ◽  
David L. Blatt ◽  
Frank J. Bova ◽  
John M. Buatti ◽  
William M. Mendenhall ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Significant Risk ◽  
Content Type ◽  
Time Period ◽  
Detailed Statistical Analysis ◽  
History Of ◽  
Hemorrhage Risk ◽  
Risk Of Hemorrhage ◽  
Parametric Survival ◽  
Arterial Aneurysms

✓ Two hundred and one patients with arteriovenous malformations (AVMs) treated radiosurgically between May 1988 and February 1995 are analyzed in this study. Twelve patients sustained a posttreatment hemorrhage during this period. Pretreatment factors associated with increased hemorrhage risk were identified in 11 of these patients and included arterial aneurysms, venous aneurysms, venous outflow obstruction, periventricular location, prior embolization, and prior surgical treatment. A detailed statistical analysis, using both Poisson regression and parametric survival regression techniques, was undertaken to determine whether radiosurgery had any effect on the risk of hemorrhage, when compared to the natural history of the disease, in those patients in whom a complete angiographic cure was not achieved. No evidence was found to support a statistically significant departure from the natural hemorrhage rate at any time period after radiosurgical treatment. Significant risk factors for hemorrhage appeared to correlate with increasing AVM volume.

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